Presentation
Disturbed level of consciousness.
Patient Data
Abnormal high signal on T2WI and FLAIR in the central pons, both caudate nuclei, the putamina, and posteromedial thalami, with lesser involvement of the medial temporal lobes and left frontoparietal subcortical region. The central pontine signal abnormality shows restricted diffusion.
Left frontal small curvilinear cortical area of low signal on all pulse sequences, possibly calcification or hemorrhage.
Endotracheal and nasogastric tubes are seen placed.
Case Discussion
This patient presented with disturbed level of consciousness and recent history of corrected hyponatremia at another hospital.
In this clinical context, the findings are most likely representing osmotic demyelination syndrome with central pontine and extrapontine myelinolysis, secondary to rapid correction of hyponatremia.
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